Snoring and Sleep Apnea

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
info@britishfaceclinic.com

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Snoring and Sleep Apnea

  • Snoring is the sound generated by the vibration of the structures at the back of your throat. Simple snoring is not associated with excessive daytime sleepiness or difficulty in sleeping at night.

    Obstructive sleep apnoea (OSA) is a condition where your breathing stops for short spells when you are asleep. However, it is not uncommon for breathing to stop for few seconds in healthy people during sleep. Only when apnoea occurs more than 5 times every hour, each time for more than 10 seconds, that it becomes a health problem and we call it OSA. During these episodes there is at least 3% to 4% fall in your blood oxygen. You wake up briefly after each episode of stopped breathing to start breathing again. You do not usually remember the times you briefly wake up, but you have a disturbed night’s sleep. This is associated with excessive daytime sleepiness, waking with gasping, choking, or breath holding. Snoring between these episodes is a frequent complaint of bed partners and is often the reason that prompts patients to seek medical attention.

    When we sleep, all the muscles in our body including the throat muscles relax and become floppy. In most people, this does not block breathing. If you have OSA, the throat muscles become so relaxed and floppy during sleep that they cause a narrowing or even a complete blockage of the airway. When your airway is narrowed it restricts flow of air, at first this causes snoring. If there is a complete blockage then your breathing actually stops (apnoea). Your blood oxygen level then goes down and your brain detects this. Your brain then tells you to wake up and you make an extra effort to breathe. Then, you start to breathe again with a few deep breaths. You will normally go back off to sleep again quickly and will not even be aware that you have woken up. Your bed partner will notice that you stop breathing for a short time, and then make a loud snore and a snort, and then get straight back off to sleep. For the diagnosis of OSA, you need to have at least five episodes of apnoea per hour of sleep. However, there are different levels of severity of OSA (mild, moderate or severe). People with severe OSA can have hundreds of episodes of apnoea each night. OSA is classified as:

    • Mild OSA – between 5-14 episodes an hour.

    • Moderate OSA – between 15-30 episodes an hour.

    • Severe OSA – more than 30 episodes an hour.

  • Studies in the western world show that snoring affects at least 40% of men and 20% of women whereas OSA is seen in 5% of men and 3% of women. Snoring or OSA can occur at any age, including in children. However, whereas snoring is very common, few of us have OSA. Remember – very few people who snore have OSA while almost all OSA patients snore!

    Factors that increase the risk of developing OSA, or can make it worse, include the following.

    • Overweight (BMI above 25) or obesity (BMI above 30)
    • Thick neck (usually if the Collar size is more than 17 inches in males or 16 inches in females) because the extra tissue in the neck can squash the airway.
    • Drinking alcohol before sleep as it causes excessive relaxation of the muscles and also makes the brain less responsive to an apnoea episode. This may lead to more severe apnoea episodes in people who may otherwise have mild OSA.
    • Enlarged tonsils and /or adenoids – This is the commonest cause in children
    • Taking sleeping tablets or tranquilizer
    • Sleeping on your back rather than on your front or side
    • Having a small or a jaw that is set back further than normal
    • Smoking – by causing an inflamed swollen airway
  • Even if you have OSA, you may not be aware of it as you will not usually remember the waking times at night. It is often your sleeping partner (or the parent if it is a child) that is concerned about the loud snoring and the recurring episodes of apnoea that they have noticed. However, you may be aware of the following problems –

    • Daytime sleepiness and being tired
    • Poor concentration and mental functioning
    • Not feeling refreshed on waking
    • Morning headaches
    • Being irritable during the day
    • Pass urine frequently during the night
    • Night sweats
    • Reduced sex drivedrive
  • In children significant OSA has been linked to poor performance in studies and sports and some studies have shown a weak link to reduced overall intellectual development.

    OSA can be a serious health problem in adults as studies have shown that OSA without treatment can either lead to or worsen the following medical conditions

    • Hypertension
    • Heart attacks
    • Stroke
    • Type 2 Diabetes Mellitus
  • OSA is diagnosed based on your complaints, the findings on your physical examination and results of tests

    Your symptoms

    If you have daytime tiredness, sometimes a questionnaire is used to measure to estimate the level of sleepiness that you feel during the daytime. A score above 10 indicates that you may have a sleeping disorder such as OSA. However, it is important to realize that many people with high score will NOT have sleep apnoea and not everyone with sleep apnoea will have a high score. Therefore, it is vital that you do not consider the score on ESS as confirmatory as this has to be combined with your complete medical assessment and other investigations.

    Tests to confirm OSA

    If you have symptoms mentioned above that suggest OSA, or a high score on the Epworth Sleepiness Scale, I may recommend certain tests. There are many types of test that can be done whilst you sleep, the most common ones are mentioned below

    • Pulse Oximeter – Monitors the oxygen level in your blood by a probe clipped on to your finger.

    • Polysomnography – This is the best but also least available and most costly test that monitors various aspects of your sleep, such as the airflow through your nose, your chest movement, the electrical activity of your brain, snoring volume, blood oxygen saturation and a video of your sleep. You may be asked to spend a night in the sleep lab for these tests to be done.
    • I may also suggest other tests to exclude other causes of your sleepiness. For example, a blood test can check for an underactive thyroid gland or overactive pituitary gland.

    Clinical Examination

    If you are bothered by significant snoring or have had tests showing OSA, physical examination is carried out to see the site that is obstructing your airway. This includes examination of your nose, throat and voice box, most commonly by a bendy camera that is passed through one of your nostrils (flexible naso-laryngoscope). This is usually done in the clinic while you are awake.

  • Before having any operation, it is advisable to consider the following treatment options as the majority of OSA patients will benefit/get cured by these.

    1. Changes to your life style and habits

    This is the first step and you may find significant benefit from making the following changes –

    • Losing some weight if you are overweight or obese
    • Not drinking alcohol for 4-6 hours before going to bed
    • Not using sedative drugs
    • Stopping smoking if you are a smoker
    • Sleeping on your side
    • Keeping props under the head end of your bed to elevate it and by using extra pillows

    2. Continuous positive airway pressure (CPAP)

    This is the most effective non-surgical treatment for OSA and should be tried before considering an operation if the changes mentioned above do not work or are not possible. This involves wearing a mask when you sleep that is connected to an electrical machine that pumps room air into your nose at a slight pressure. The air pressure keeps the throat open when you are breathing at night and so prevents the blockage of airflow. If CPAP works, then snoring is reduced or stopped and there is an immediate improvement in sleep. Lifelong treatment is needed. Sometimes you can have problems with throat irritation or dryness or bleeding inside you nose, which can be treated by newer CPAP machines that tend to have a humidifier fitted. Some people find the device cumbersome to wear at night. Due to these problems, around 40% to 50% OSA patients fail to use CPAP for long.

    3. Mandibular advancement devices

    These are devices that you can wear inside your mouth when you sleep. They work by pulling the mandible forward a little so that your throat may not narrow as much in the night. These devices look a bit like gum shields that sports-people wear. To get the best results, you should get one properly fitted by a dentist that is tailor made to the shape of your teeth and gum.

  • The aim of operation is to increase the airflow into your airway. The correct surgery for you would depend upon where your obstruction is and to what degree. As mentioned above, an accurate evaluation is critical to decide this so that the correct surgery is carried out for you

    1. Tonsillectomy +/- Adenoidectomy
    This is most commonly done in children with significant snoring or OSAS as a relative large size of these structures is the commonest cause in that age group. Occasionally, adults have enlarged tonsils and will benefit from their removal.

    2. Nose Surgery
    It Is rare for your nose to be the cause of obstruction. If they are, operation to straighten the nose, the septum inside or to widen the inside can be done. This can also be very useful if blockage in your nose is making it difficult for you to use the CPAP machine.

    3. Palatal Z plasty / Modified Uvulopalatopharyngoplasty (UVPP)
    is a procedure used to remove excess tissue in the throat to widen and allow air to move through the throat more easily when you breathe, reducing snoring. The tissues removed may include:

    • The small finger-shaped piece of tissue (uvula) that hangs down from the back of the roof of the mouth into the throat.
    • Part of the roof of the mouth (Soft Palate)
    • Enlarged throat tissue, tonsils and adenoids

    Please read the page

    http://britishfaceclinic.com/sleep-and-snoring/snoring-sleep-apnea/palatal-z-plasty-modified-uvpp/

    What To Expect After UVPP
    It takes about 3 weeks to recover from surgery. It can be quite painful and it may be very difficult to swallow during this time. In addition it is usual to notice small amount in blood in your throat or sputum while the wound heals itself. During the healing period, you may find yourself choking, especially when you drink thin fluid. You are likely to notice improvement at about 3-4 weeks after the operation.

    How successful is UVPP?
    The success of UVPP is dependent on proper patient selection based on good examination by experienced clinician. In carefully selected patients it can cure snoring in 80% of those who have had this surgery.

    What are the risks / potential complications of UVPP?
    Like any other surgery, UVPP has some possible known complications that are mentioned below

    • Swelling, infection, and bleeding
    • Pain and trouble swallowing
    • Drainage of secretions into the nose and a nasal quality to the voice. Speech may be affected by this surgery
    • Narrowing of the airway in the nose and throat
    • Recurrence of snoring or OSA after a year or two

    The last three complications mentioned above are relatively common with old-fashioned UVPP. However the modified UVPP I offer has tremendously reduced these risks. I practice this modified technique of UVPP (Z-Palatoplasty) and I have found a very high satisfaction and success rate in my patients.

    4. Procedures for the roof of your mouth (Palate)
    In some patients, surgery for roof of mouth is required as that is the main site of obstruction. The choice of procedure depends on the degree of obstruction related to how much excess tissue you have. Naturally, precise diagnosis is crucial for successful treatment. By themselves, they are more useful for snoring but can be useful if done with one of the procedure mentioned above if you have sleep apnoea.

    Please read the page
    http://britishfaceclinic.com/sleep-and-snoring/snoring-sleep-apnea/coblation-soft-palate-tongue/